After skin has been wounded or burned, the opening must be closed to speed wound healing. In the cases of severe wounds or burns, there is insufficient excess skin around the sides of the defect to allow the sides to be pulled together. Similarly, when diseased or blemished cutaneous tissue is removed by surgery, insufficient skin may be left around the perimeter of the removed tissue. In the event the defect is large and cannot be easily closed, techniques have been developed for wound closure.
Two surgical techniques are skin grafts and skin flaps, both of which require the elevation of skin. Skin is incised and elevated from an area near the defect or from another part of the body. This invasive surgical procedure requires anesthesia, has substantial costs and requires hospitalization. Rigid asepsis is necessary. Further, there is the risk of complications which include skin ischemia and necrosis, infection, seroma and hematoma.
Another technique is the use of skin expanders. Skin expanders are implanted under the skin and slowly inflated to expand the skin. This technique is expensive. After gradual inflation of the expander, a second surgical procedure is required to rotate or advance the skin in the form of a flap. It requires surgical implantation, anesthesia, and hospitalization. As with skin grafts, rigid asepsis is necessary. The risk of complications include infection, implant extrusion, ischemia, necrosis, scar encapsulation of the silastic implant, hematoma and/or seroma formation.
A fourth technique is presuturing where the neighboring skin is folded temporarily over the proposed surgical site with sutures prior to the surgery, to facilitate wound closure as the skin relaxes to the tension applied by the sutures. Presuturing is minimally invasive because only placement of the suture needle is required prior to the elective surgical procedure. Local anesthesia is required for suture placement. The sutures are tightened but no adjustment is possible once the sutures have been placed in the skin. The sutures can be uncomfortable. There is a small risk of infection and the sutures have a limited surface area of application for closing open wounds.
A fifth and more recently developed technique, disclosed in U.S. Pat. No. 5,234,462, issued to Pavletic on Aug. 10, 1993, is a method which includes attaching a plurality of anchors to the surface of the skin adjacent to the wound with an adhesive. At least one elastomeric strap is positioned across the wound and is attached to the anchors. The tension of the elastomeric strap is adjusted periodically to maintain sufficient tension to progressively stretch the skin proximate to the fasteners over time.